Prepared by J. Richard Woy, Ph.D. JRW Associates For panel presentation at

1. Issues and Selected findings: Assessment of Prescription Drug Misuse by Youth in BostonPFS2 Initiative Boston Public Health Commission Prepared by J. Richard Woy, Ph.D. JRW Associates For panel presentation at Statewide Substance Abuse Prevention Conference, October 30, 2014

2. Outline of Presentation - I. Background and purposes - II. Challenges and attempted solutions - III. Methods - IV. Findings: Youth surveys - V. Findings: Parent survey - VI. Findings: Provider focus groups - VII. Use of findings: PFS2 Boston program design

3. I. Background and Purposes Background: • There currently is a three-year PFS2 Initiative underway in Boston. Funded by BSAS and directed by the Boston Public Health Commission (BPHC), the Initiative began in late 2012 and is now late in its second year of implementation. • Most of Year 01 was devoted to needs/assets assessment, development of the strategic plan and evaluation plan, and establishment of baseline measures for the Initiative. • The needs/assets assessment and issues associated with it are the primary focus of this presentation.

4. Background and Purposes (Continued) Purposes: • The needs/assets assessment was intended to: (1) provide an empirical basis for development of the strategic plan and evaluation plan; and (2) to establish baseline measures against which to measure success of the Initiative. • Purposes of this presentation are: (1) to explore challenges encountered and our attempts at solutions; (2) to present selected findings from the assessment; and (3) then how we are using the findings for program development, implementation, and evaluation.

5. II. Challenges and Attempted Solutions Challenges: • Limited existing data on NMUPD by youth in Boston. • No ready access to large representative samples of youth to survey in Boston. (In particular, no access to survey youth in Boston Public Schools) • Scope and complexity of a major city. • Large bureaucracies • Many neighborhoods • Many service sectors and providers • Limited resources for assessment.

6. Challenges and Attempted Solutions (Cont’d) Attempted solutions: • Collection and review of all existing recent data on NMUPD by youth in Massachusetts and Boston. • Use of “convenience samples” to survey youth and parents of youth: • Baseline surveys/youth: Focus groups with youth • Baseline surveys/parents: Parent University, Boston Public Schools • Heavy reliance on qualitative methods, including: (1) focus groups; and (2) key informant interviews. • Design Team and BPHC resources/network. • “Convergent” analysis.

7. III. Methods Data collection re NMUPD by youth in Boston: • Survey of youth in focus groups (N=74) • Survey of parents in Parent University (N=53) • 11 focus groups with youth (N=101), including many neighborhoods and types of settings (e.g., after school programs; residential drug treatment programs; certain public schools). • 2 focus groups with service providers (N=21), one group serving youth 12-17 years of age and one group serving youth ages 18 to 25 years.

8. Methods (Continued) Data collection re NMUPD by youth in Boston: • 10 key informant telephone interviews with experts and opinion leaders re NMUPD by youth in Boston. • Survey of healthcare providers attending a workshop entitled “Prescribing Practices and Poly Drug Abuse” (N=14).

9. IV. Survey Findings: NMUPD by Youth

10. Survey findings: NMUPD by Youth (Cont’d) PFS2 survey: Additional observations • Lifetime rates substantially higher than current rates. • Reported rates very low in 12-14 year old range and then increasing through high school years. • Most who reported lifetime NMUPD reported misuse of multiple types of drugs, including narcotics/opioids (75%), Ritalin or Adderall (81%), and Other drugs (81%). • Risk of harm: Respondents rated heroin very risky, prescription narcotics and other prescription drugs moderately risky, and marijuana least risky. • Access: Respondents rated alcohol fairly easy to obtain and prescription drugs and marijuana only fairly difficult.

11. V. Findings: PFS2 Parent Survey

12. Findings: PFS2 Parent Survey (Cont’d) Additional observations: • Youth substance use: Reported use rates in this sample were less than half the rates reported by youth themselves. • Text responses: While parents reported that it was easy to talk to their children about drugs and that they had done so, in written responses to open-ended questions they also identified a number of challenges in this area as well as suggesting a number of types of information that might be helpful to them as parents in their efforts to protect their children from the dangers of drugs and NMUPD.

13. VI. Findings: Focus Groups with Providers Scope, characteristics, and seriousness: • Youth NMUPD a serious problem in Boston. • Problem is trending up and moving lower in age. • Involves multiple drugs in addition to opioids. • Involves both genders and many racial/ethnic groups. • Tends to start with experimentation at home and with peers and often is a gateway to other street drugs. • May be more frequent among drug users under 25 years than among older drug users. • May sometimes be part of larger pattern of trauma/abuse. • May be a different pattern among college students.

14. Findings: Provider Focus Groups (Cont’d) Key risk factors: • Easy access to prescription drugs from parents, friends, and doctors’ prescriptions, as well as illegally. • Youth and society as a whole tend to view prescription drugs as acceptable and safe, unlike use of street drugs. • Insufficient knowledge and awareness of the dangers of NMUPD. • Peer pressure. • Trauma and/or neglect in childhood.

15. Findings: Provider Focus Groups (Cont’d) Suggested solutions: • Educate youth regarding risks/dangers of NMUPD before they start using, e.g. reverse perception that prescription drugs are acceptable and safe. • Educate/involve parents re risks/dangers of NMUPD and how to reduce access to prescription drugs at home. • Educate/involve providers, especially doctors and dentists around reducing over-prescribing and adherence to best practices re prescription of drugs. • Create universal drug prescription data base.

16. VII. Use of Findings in Program Design and Implementation PFS2 Boston program design, based on the above findings: • Goal: Reduce the number of youth ages 12 to 17 years in Boston who initiate NMUPD. • Primary intervening variables/risk factors: (1) low perception of risk/harm; and (2) easy access to PD’s. • Other intervening variables: (1) extent of peer approval of NMUPD; (2) extent of parental/caregiver and prescriber approval/disapproval of NMUPD. • Target groups: (1) Youth; (2) Parents; and (3) Providers.

17. Use of Findings (Cont’d) PFS2 Boston program design, based on the above findings: • Strategies/Youth: City-wide awareness projects and local neighborhood education efforts targeting youth to address perception of risk/harm issue. • Strategies/Parents: Through BPS Parent University, provide education and try to mobilize parents on perception of risk/harm issue and ways to reduce access at home. • Strategies/Providers: Through collaboration with BU Scope of Pain project, provide education and try to mobilize health care providers to address access issue.

18. For additional information For additional information, contact: J. Richard Woy JRW Associates O: 617-731-9852 Email: jrwoy@aol.com